BMC Anesthesiology最新文献

{"title":"Remimazolam for the prevention of emergence agitation in adults following nasal surgery under general anesthesia: a prospective randomized clinical controlled trial.","authors":"Yanfei Lu, Qiaomin Xu, Hong Dai, Jimin Wu, Mengting Ai, Haiyan Lan, Xiaoli Dong, Gongchen Duan","doi":"10.1186/s12871-024-02875-1","DOIUrl":"10.1186/s12871-024-02875-1","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam is a novel intravenous sedative/anesthetic drug that belongs to the ultra-short-acting class of benzodiazepines. The purpose of this study was to evaluate the effectiveness of postoperative use of remimazolam in preventing emergence agitation (EA) in adults following nasal surgery.</p><p><strong>Methods: </strong>Patients who underwent nasal surgery were randomly divided into Group R and Group C. Propofol, sufentanil, and cis-atracurium were used for the induction of anesthesia, and 1.5-3.5% sevoflurane was used for the maintenance of anesthesia. At the end of the surgery, patients were randomly assigned to receive either remimazolam 0.1 mg kg^- 1 (Group R, n = 43) or 0.9% saline (Group C, n = 43). The primary outcome was the incidence of EA, which was defined as a Riker Sedation-Agitation Scale score > 4. The secondary outcomes included the incidence of severe EA, anesthesia, surgery characteristics, adverse events, mean arterial pressure, and heart rate (at different time points).</p><p><strong>Results: </strong>A total of 86 adult patients completed the study. The incidence of EA was lower in Group R than in Group C (21% vs. 49%, P = 0.007). The incidence of severe EA was also lower in Group R than in Group C (2% vs. 19%, P = 0.035). The maximal Sedation-Agitation Scale score during emergence was lower in Group R 4 [range 4 to 4] than in Group C 5 [range 4 to 6] (P < 0.001). In addition, the incidence of hypertension and grade of cough in Group R were lower than in Group C (P = 0.024). During emergence, the mean arterial pressure and heart rate of group R showed more stability than those in group C.</p><p><strong>Conclusions: </strong>Postoperative intravenous infusion of 0.1 mg/kg remimazolam into adult patients undergoing nasal surgery can reduce the incidence of EA and severe EA, and provide stable hemodynamics.</p><p><strong>Trial registration: </strong>The trial was registered, before patient enrollment, in the Chinese Clinical Trial Registry ( www.chictr.org.cn ) (clinical trial number: ChiCTR2300075300; Principal Investigator: Gongchen Duan; date of registration: 31 August 2023; https://www.chictr.org.cn/bin/project/edit?pid=203928 ).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"8"},"PeriodicalIF":2.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful awake intubation using Airtraq^® in a low-resource setting for a patient with severe post-burn contractures.","authors":"Simon Ponthus, Martina Odiakosa, Bertrand Gautier, Lionel Dumont","doi":"10.1186/s12871-024-02887-x","DOIUrl":"https://doi.org/10.1186/s12871-024-02887-x","url":null,"abstract":"<p><strong>Background: </strong>In resource-limited settings, advanced airway management tools like fiberoptic bronchoscopes are often unavailable, creating challenges for managing difficult airways. We present the case of a 25-year-old male with post-burn contractures of the face, neck, and thorax in Nigeria, who had been repeatedly denied surgery due to the high risk of airway management complications. This case highlights how an awake intubation was safely performed using an Airtraq^® laryngoscope, the only device available, as fiberoptic intubation was not an option. The patient had a mouth opening of 3.5 cm, a Mallampati score of 4, and no neck extension, making intubation challenging. Pre-procedural counseling was provided, and after explaining the risks, the patient gave informed consent.</p><p><strong>Case presentation: </strong>Preoxygenation was performed, followed by topical anesthesia using lidocaine gargles and incremental spraying of lidocaine to the vocal cords via a feeding tube. The Airtraq^® laryngoscope enabled glottic visualization despite limited neck mobility and challenging anatomy. Procedural challenges included managing aspiration during gargling, precise lidocaine application without advanced tools, and maintaining patient cooperation. The procedure was successfully completed, allowing surgery for contracture release.</p><p><strong>Conclusions: </strong>This case emphasizes that safe awake intubation with an Airtraq^® laryngoscope is feasible in low-resource environments when key principles-oxygenation, topical anesthesia, and careful procedural steps-are followed. The reuse of a single-use device like the Airtraq^® laryngoscope extends its utility in resource-constrained settings, enabling complex airway management when alternatives are unavailable. The patient tolerated the procedure well and reported minimal discomfort. This experience underscores the critical importance of innovation, resourcefulness, and patient cooperation in managing difficult airways when standard tools are unavailable, offering valuable lessons for similar resource-constrained environments.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"12"},"PeriodicalIF":2.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paracetamol did not improve the analgesic efficacy with regional block after video assisted thoracoscopic surgery: a randomized controlled trial.","authors":"Sujin Kim, Seung Woo Song, Haesung Lee, Chun Sung Byun, Ji-Hyoung Park","doi":"10.1186/s12871-025-02888-4","DOIUrl":"10.1186/s12871-025-02888-4","url":null,"abstract":"<p><strong>Background: </strong>Various analgesic techniques have been applied, the pain after video assisted thoracic surgery (VATS) is still challenging for anesthesiologists. Paracetamol provide analgesic efficacy in many surgeries. However, clinical evidence in the lung surgery with regional block remain limited. This monocentric double-blind randomized controlled trial investigates the efficacy of paracetamol after VATS with regional block.</p><p><strong>Methods: </strong>A total of 90 patients were randomized to receive paracetamol (1 g) or normal saline. Erector Spinae Plane Block and Intercostal Nerve block were applied during the surgery. The Visual Analogue Scales (VAS) pain score was measured in the PACU as well as 6, 12, 24, and 48 h postoperatively. And the total dose of rescue analgesics administered to patients in morphine milligram equivalents (MME), satisfaction score, length of hospital stays, and incidence of nausea and vomiting were also recorded.</p><p><strong>Results: </strong>The VAS pain score at each time point, the primary endpoint, did not differ between the groups (3.09 ± 2.14 vs. 2.53 ± 1.67, p = 0.174 at PACU; 4.56 ± 2.80 vs. 4.06 ± 2.46, p = 0.368 at 6 h; 3.07 ± 1.98 vs. 3.44 ± 2.48, p = 0.427 at 12 h; 2.10 ± 2.00 vs. 2.49 ± 2.07, p = 0.368 at 24 h; and 1.93 ± 1.76 vs. 2.39 ± 1.97, p = 0.251 at 48 h postoperatively). Satisfaction scores (4.37 ± 0.76 vs. 4.14 ± 0.88, p = 0.201), nausea (35.6% vs. 37.8%, p = 0.827), hypotension (2.2% vs. 0.0%, p = 0.317), and bradycardia (6.7% vs. 2.2%, p = 0.309) were also reported at similar rates.</p><p><strong>Conclusions: </strong>The analgesic efficacy of one gram of paracetamol with ESPB and ICNB after VATS was not proven. Thus, caution should be exercised when prescribing paracetamol for pain control during VATS.</p><p><strong>Trial registration: </strong>this trial was registered on Clinical Research Information Service (CRIS), Republic of Korea (KCT0008710). Registration date: 17/08/2023.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"11"},"PeriodicalIF":2.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intertransverse process block versus subcostal transversus abdominis plane block in patients undergoing laparoscopic radical gastrectomy: a prospective randomized controlled trial.","authors":"Qian Chen, Xinyue Zhou, Fang Wang, Yang Zeng, Bin Qian, Haiyun Du","doi":"10.1186/s12871-024-02884-0","DOIUrl":"10.1186/s12871-024-02884-0","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic radical gastrectomy has been reported to be associated with substantial trauma and pain. This study compared the impact of ultrasound-(US)-guided, bilateral, double-injection intertransverse process block (ITPB) on postoperative analgesia with subcostal transversus abdominis plane block (TAPB) in patients who were undergoing laparoscopic radical gastrectomy.</p><p><strong>Methods: </strong>Sixty-two patients who were undergoing laparoscopic radical gastrectomy surgery under general anesthesia were included. These patients were randomized to either the ITPB group or the TAPB group. Patients in the ITPB group received a double-shot US-guided bilateral ITPB at the thoracic level T6/7 and T9/10 level using ropivacaine (0.3%, 15 mL). Patients in the TAPB group received bilateral subcostal TAPB one injection per side using ropivacaine (0.3%, 30 mL). All patients used a BIS-guided combined intravenous and inhalation anesthesia. The primary outcome was defined as postoperative morphine-equivalent consumption during the first 24 h.</p><p><strong>Results: </strong>The study recruited 62 patients (31 in each group) for the analysis. A comparatively less postoperative opioid consumption was observed in the ITPB group compared with the subcostal TAPB group within the first 24 h postoperatively (mean [standard deviation-(SD)] morphine-equivalent dose): 27.8 (5.7) mg vs 31.2 (4.4) mg, P < 0.001. The ITPB group showed lower intraoperative opioid use, and statistical significantly lower scores at rest and coughing at 6, 24 h postoperatively. The time to first requiring rescue analgesia was longer in the ITPB group than the subcostal TAPB group (median [IQR]): 8.0 [8.0] vs 6.0 [6.0] h, P = 0.009. The patients in the ITPB group exhibited earlier independent movement, lower incidence of postoperative complications and higher levels of satisfaction (P = 0.021).</p><p><strong>Conclusion: </strong>This study showed that the double-shot bilateral ITPB could reduce opioids consumption and achieve longer and better pain relief. Additionally, it promoted early postoperative activity and improved patient satisfaction.</p><p><strong>Trial registration: </strong>ChiCTR2300072986. Registered 29 June 2023.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"9"},"PeriodicalIF":2.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of epidural esketamine versus sufentanil on labor analgesia and postpartum depression: a retrospective cohort study.","authors":"Kunyue Li, Ziqi Chai, Chunyun Deng, Guoying Niu, Xiaoyuan Geng, Yu Zhang, Yuxia Wang, Tao Wang","doi":"10.1186/s12871-024-02846-6","DOIUrl":"https://doi.org/10.1186/s12871-024-02846-6","url":null,"abstract":"<p><strong>Objective: </strong>There is a lack of research on epidural esketamine for labor analgesia. The purpose of this research is to compare the efficacy of epidural esketamine and sufentanil on labor analgesia and postpartum depression.</p><p><strong>Methods: </strong>A total of 187 cephalic full-term parturients with single-fetus vaginal delivery were collected in this retrospective study from Jan 2022 to Jan 2023. Parturients were categorized into two groups according to anesthetics: the esketamine group (Group KR, n = 97) with patient-controlled epidural analgesia with 0.3 mg/ml esketamine and 0.083% ropivacaine in 240 ml of normal saline and the Sufentanil group (Group SR, n = 90) with 0.3 µg/ml sufentanil and 0.083% ropivacaine in 240 ml of normal saline. The Visual Analogue Scale, Ramsay Sedation Scale, and Modified Bromage Score were recorded before, 5, 10, and 30 min after analgesia, when the uterine orifice was fully opened, and after delivery. The Edinburgh Postnatal Depression Scale(EPDS) scores at 3 and 42 days after delivery were recorded. The maternal and infant outcomes and occurrence of maternal adverse reactions were recorded.</p><p><strong>Results: </strong>The VAS scores after analgesia at 5,10,30 min and when the cervix was fully opened were higher in Group KR than Group SR (all P < 0.05). RSS scores at 5,10,30 min after analgesia in group KR were lower in Group KR than Group SR (all P < 0.05). Compared with group SR, significant decreases were shown in the EPDS and the incidence of postpartum depression at 42 days after delivery in Group KR (all P < 0.05). Group KR has considerably decreased rates of pruritus compared to Group SR (P < 0.05). The other adverse effects showed no significant difference (all P > 0.05). The maternal and neonatal outcomes were not significantly different between the two groups (all P > 0.05).</p><p><strong>Conclusions: </strong>In comparison to sufentanil, epidural esketamine for labor analgesia may exhibit a better sedative effect, and a low incidence of pruritus, but a limited analgesic effect. It may be associated with a lower risk of postpartum depression. Further exploration of the optimal regimen and dosage of esketamine for epidural labor analgesia would be necessary.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"6"},"PeriodicalIF":2.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Norepinephrine titration in patients with sepsis-induced encephalopathy: cerebral pulsatility index compared to mean arterial pressure guided protocol: randomized controlled trial.","authors":"Mai Salah Salem, Motaz Amr Abosabaa, Mohamed Samir Abd El Ghafar, Hala Mohey Ei-Deen Mohamed Ei-Gendy, Salah El-Din Ibrahim Alsherif","doi":"10.1186/s12871-024-02814-0","DOIUrl":"https://doi.org/10.1186/s12871-024-02814-0","url":null,"abstract":"<p><strong>Background: </strong>Although surviving sepsis campaign (SSC) guidelines are the standard for sepsis and septic shock management, outcomes are still unfavourable. Given that perfusion pressure in sepsis is heterogeneous among patients and within the same patient; we evaluated the impact of individualized hemodynamic management via the transcranial Doppler (TCD) pulsatility index (PI) on mortality and outcomes among sepsis-induced encephalopathy (SIE) patients.</p><p><strong>Methods: </strong>In this prospective, single-center randomized controlled study, 112 patients with SIE were randomly assigned. Mean arterial pressure (MAP) and norepinephrine (NE) titration were guided via the TCD pulsatility index to achieve a pulsatility index < 1.3 in Group I, whereas the SSC guidelines were used in Group II to achieve a MAP ≥ 65 mmHg. The primary outcome was intensive care unit (ICU) mortality and the secondary outcomes were; MAP that was measured invasively and values were recorded; daily in the morning, at the end of NE infusion and the end of ICU stay, duration of ICU stay, cerebral perfusion pressure (CPP), sequential organ failure assessment (SOFA) score, norepinephrine titration and Glasgow coma scale (GCS) score at discharge.</p><p><strong>Results: </strong>ICU mortality percentage wasn`t significantly different between the two groups (p value 0.174). There was a significant increase in the MAP at the end of norepinephrine infusion (mean value of 69.54 ± 10.42 and p value 0.002) and in the GCS score at ICU discharge (Median value of 15 and p value 0.014) in the TCD group, and episodes of cerebral hypoperfusion with CPP < 60 mmHg, were significantly lower in the TCD group (median value of 2 and p value 0.018). Heart rate values, number of episodes of tachycardia or bradycardia, Total norepinephrine dosing, duration of norepinephrine infusion, SOFA score, serum lactate levels, and ICU stay duration weren`t significantly different between the two groups.</p><p><strong>Conclusions: </strong>Individualizing hemodynamic management via the TCD pulsatility index in SIE patients was not associated with significant mortality reduction. However, it reduces episodes of cerebral hypoperfusion and improves GCS outcome but doesn't significantly affect heart rate values, SOFA score, serum lactate level, length of ICU stay, total NE dosing, and duration of NE infusion.</p><p><strong>Trial registration: </strong>The clinical trial was registered on clinucaltrials.gov under the identifier NCT05842616 https://clinicaltrials.gov/study/NCT05842616?cond=NCT05842616&rank=1 on 6-May-2023 before the enrolment of the first patient.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"5"},"PeriodicalIF":2.3,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic impact of prolonged tracheal extubation times on operating room time overall and for subgroups of surgeons: a historical cohort study.","authors":"Franklin Dexter, Anil A Marian, Richard H Epstein","doi":"10.1186/s12871-024-02862-6","DOIUrl":"https://doi.org/10.1186/s12871-024-02862-6","url":null,"abstract":"<p><strong>Background: </strong>Prolonged tracheal extubation time is defined as an interval ≥ 15 min from the end of surgery to extubation. An earlier study showed that prolonged extubations had a mean 12.4 min longer time from the end of surgery to operating room (OR) exit. Prolonged extubations usually (57%) were observed during OR days with > 8 h of cases and turnovers, such that longer OR times from prolonged extubation can be treated as a variable cost (i.e., each added minute incurs an expense). The current study addressed limitations of the generalizability of these earlier investigations.</p><p><strong>Methods: </strong>The retrospective cohort study included cases performed at a university hospital October 2011 through June 2023 with general anesthesia, tracheal intubation and extubation in the OR where the anesthetic was performed, and non-prone positioning. The primary endpoint was the interval from end of surgery to OR exit. Mean OR time differences with/without prolonged extubation were analyzed pairwise by surgeon. The variance among surgeons was estimated using the DerSimonian-Laird method with Knapp-Hartung adjustment for the sample sizes of surgeons. Proportions were analyzed after arcsine transformation, and the inverse taken to report results.</p><p><strong>Results: </strong>There were prolonged extubations for 23% (41,768/182,374) of cases. Prolonged extubations had a mean 13.3 min longer time from the end of surgery to OR exit (95% confidence interval 12.8-13.7 min, P < 0.0001). That result was among the 71 surgeons each with ≥ 9 cases having prolonged extubation times and ≥ 9 cases with typical extubation times. Results were similar using a threshold of ≥ 3 cases, comprising 257 surgeons (13.2 min, P < 0.0001). Among the 71 surgeons with at least nine prolonged extubations, on most days with a prolonged extubation during at least one of their cases, there were > 8 h of cases and turnover times in the OR (77%, 73%-81%, P < 0.0001). Results were similar when analyzed for the 249 surgeons each with ≥ 3 cases with prolonged extubation (76%, P < 0.0001).</p><p><strong>Conclusions: </strong>Matching earlier findings, prolonged tracheal extubation times are important economically, increasing OR time by 13 min and usually performed in ORs with lists of cases of sufficient duration to treat the extra time as a variable cost.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"4"},"PeriodicalIF":2.3,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of serum chloride levels with all-cause mortality among patients in surgical intensive care units: a retrospective analysis of the MIMIC-IV database.","authors":"Quan Ma, Wei Tian, Kaifeng Wang, Bin Xu, Tianyu Lou","doi":"10.1186/s12871-024-02870-6","DOIUrl":"10.1186/s12871-024-02870-6","url":null,"abstract":"<p><p>This study explores the association between serum chloride concentrations and all-cause mortality among patients in the Surgical Intensive Care Unit (SICU). Employing a retrospective cohort design, the study utilized data extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, specifically focusing on individuals admitted to the surgical/trauma ICUs. This dataset encompassed demographic profiles, laboratory findings, historical medical data, vital statistics, and variables pertinent to prognosis. Participants were divided into four groups based on their serum chloride concentrations. The primary outcomes assessed were mortality rates at 30, 90, and 180 days post-admission to the ICU. Analytical methods included Kaplan-Meier survival curves, Cox proportional hazards regression models, and Restricted Cubic Spline (RCS) analyses to delineate the relationship between serum chloride concentrations and patient outcomes. The study cohort comprised 10,996 patients, with observed mortality rates of 12.78% at 30 days, 17.14% at 90 days, and 20.32% at 180 days. Kaplan-Meier analyses revealed significant disparities in survival rates across the quartiles of serum chloride during the follow-up intervals (p < 0.001). The results from the multivariable Cox regression suggested a substantial inverse association between high serum chloride levels and decreased mortality at 30 days (hazard ratio [HR]: 0.96; 95%confidence interval [CI]: 0.95-0.97; P < 0.001), 90 days (HR: 0.97; 95% CI: 0.96-0.98; P < 0.001), and 180 days (HR: 0.97; 95% CI: 0.96-0.98; P < 0.001). Particularly, patients in the highest quartile of serum chloride faced significantly lower mortality risks compared to those in the lowest quartile (30 days HR = 0.65, 90 days HR = 0.71, 180 days HR = 0.69, P < 0.001). RCS analysis depicted an L-shaped curve demonstrating the dynamics between serum chloride concentrations and the risk of all-cause mortality across the 30-day, 90-day, and 180-day periods.Starting at a concentration of 104 mmol/L, a decrease in serum chloride levels was associated with an increased risk of mortality.These findings elucidate a marked nonlinear association between serum chloride levels and all-cause mortality in SICU patients, enhancing our comprehension of serum chloride's impact on clinical outcomes in this setting.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"3"},"PeriodicalIF":2.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of AI applications and anesthesiologist's anesthesia method choices.","authors":"Enes Çelik, Mehmet Ali Turgut, Mesut Aydoğan, Metin Kılınç, İzzettin Toktaş, Hakan Akelma","doi":"10.1186/s12871-024-02882-2","DOIUrl":"10.1186/s12871-024-02882-2","url":null,"abstract":"<p><strong>Background: </strong>In medicine, Artificial intelligence has begun to be utilized in nearly every domain, from medical devices to the interpretation of imaging studies. There is still a need for more experience and more studies related to the comprehensive use of AI in medicine. The aim of the present study is to evaluate the ability of AI to make decisions regarding anesthesia methods and to compare the most popular AI programs from this perspective.</p><p><strong>Methods: </strong>The study included orthopedic patients over 18 years of age scheduled for limb surgery within a 1-month period. Patients classified as ASA I-III who were evaluated in the anesthesia clinic during the preoperative period were included in the study. The anesthesia method preferred by the anesthesiologist during the operation and the patient's demographic data, comorbidities, medications, and surgical history were recorded. The obtained patient data were discussed as if presenting a patient scenario using the free versions of the ChatGPT, Copilot, and Gemini applications by a different anesthesiologist who did not perform the operation.</p><p><strong>Results: </strong>Over the course of 1 month, a total of 72 patients were enrolled in the study. It was observed that both the anesthesia specialists and the Gemini application chose spinal anesthesia for the same patient in 68.5% of cases. This rate was higher compared to the other AI applications. For patients taking medication, it was observed that the Gemini application presented choices that were highly compatible (85.7%) with the anesthesiologists' preferences.</p><p><strong>Conclusion: </strong>AI cannot fully master the guidelines and exceptional and specific cases that arrive in the course of medical treatment. Thus, we believe that AI can serve as a valuable assistant rather than replacing doctors.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"2"},"PeriodicalIF":2.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous anesthesia with high-flow nasal cannula improves recovery in elderly undergoing ureteroscopic lithotripsy: a prospective controlled study.","authors":"Lifei Tang, Ran Guo, Yaochen Quan, Haiwen Zhang, Yingcong Qian, Youjia Yu, Shaoyong Song, Jian Li","doi":"10.1186/s12871-024-02869-z","DOIUrl":"10.1186/s12871-024-02869-z","url":null,"abstract":"<p><strong>Background: </strong>Intravenous anesthesia with high-flow nasal cannula (HFNC) has been reported to benefit oxygen reserves and enhance postoperative recovery in surgeries requiring low neuromuscular blockade. This study investigated whether HFNC improves recovery quality in elderly undergoing ureteroscopic holmium laser lithotripsy (UHLL).</p><p><strong>Methods: </strong>We enrolled 106 elderly patients undergoing UHLL, with 96 patients (48 per group) included in the final analysis. Patients were randomly assigned (1:1, stratified by sex) to receive either HFNC (HFNC group) or laryngeal mask airway (LMA) assisted general anesthesia (LMA group). The primary outcome was the Quality of Recovery 15-questionnaire (QoR-15) scores. Secondary outcomes included PACU stay duration, time to out-of-bed mobilization, length of hospital stay, airway dryness scores, surgeons' satisfaction, and postoperative complications.</p><p><strong>Results: </strong>Compared to the LMA group, the HFNC group achieved significantly higher QoR-15 scores (125.5 [118.3-130.0] vs. 136.5 [126.3-139.0]; difference = -9, 95%CI, -11 to -5; P < 0.001) on the first postoperative day. For secondary outcomes, the HFNC group had a shorter PACU stay (difference = 11.6 min, 95% CI, 10.4-12.8 min), earlier out-of-bed mobilization (difference = 31.8 min, 95% CI, 30.6-33.1 min), lower mouth (difference = 2, 95% CI, 1-3) and throat dryness scores (difference = 2, 95% CI, 1-3) at 30 min post-operation, and lower rates of postoperative sore throat (14.6% vs. 0%; P = 0.019) and cough with sputum (odds ratio [OR] = 9.4, 95% CI, 1.1-78.4). No significant differences were observed between the groups for other measures.</p><p><strong>Conclusions: </strong>HFNC can improve recovery quality in elderly patients after UHLL compared to LMA-assisted general anesthesia.</p><p><strong>Trial registration: </strong>This trial was registered on July 20, 2023, in the Chinese Clinical Trial Registry (ChiCTR2300073757).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11694365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}